Thomas Cuisset1,2,3, Pierre Deharo1,3,4, Jacques Quilici5, Thomas W Johnson4, Stéphanie Deffarges1,3, Clémence Bassez1,3, Guillaume Bonnet1,3, Laurent Fourcade6, Jean Philippe Mouret1,3, Marc Lambert1,3, Valentine Verdier7, Pierre Emmanuel Morange2,3,8, Marie Christine Alessi2,3,8, Jean Louis Bonnet1,2,3. 1. Département de Cardiologie, CHU Timone, Marseille F-13385, France. 2. INSERM, UMR1062, « Nutrition, Obesity and Risk of Thrombosis », Marseille F-13385, France. 3. Faculté de Médecine, Aix-Marseille Université, Marseille F-13385, France. 4. Cardiology Department, Bristol Heart Institute, Upper Maudlin Street BS28HW, Bristol, UK. 5. Departement de Cardiologie, Centre Hospitalier de GAP, 1 Place Auguste Muret 05000, GAP, France. 6. Cardiologie, Hôpital d'instruction des Armées, LAVERAN, 34 bd Laveran 13013, Marseille, France. 7. Research Unit, UMAI, APHM, Marseille, France. 8. Laboratoire d'Hématologie, CHU Timone, Marseille F-13385, France.
Abstract
AIMS: Newer P2Y12 blockers (prasugrel and ticagrelor) demonstrated significant ischaemic benefit over clopidogrel after acute coronary syndrome (ACS). However, both drugs are associated with an increase in bleeding complications. The objective of the present study was to evaluate the benefit of switching dual antiplatelet therapy (DAPT) from aspirin plus a newer P2Y12 blocker to aspirin plus clopidogrel 1 month after ACS. METHODS AND RESULTS: We performed an open-label, monocentric, and randomized trial. From March 2014 to April 2016, patients admitted with ACS requiring coronary intervention, on aspirin and a newer P2Y12 blocker and without adverse event at 1 month, were assigned to switch to aspirin and clopidogrel (switched DAPT) or continuation of their drug regimen (unchanged DAPT). The primary outcome was a composite of cardiovascular death, urgent revascularization, stroke and bleeding as defined by the Bleeding Academic Research Consortium (BARC) classification ≥2 at 1 year post ACS. Six hundred and forty six patients were randomized and 645 analysed, corresponding to 322 patients in the switched DAPT and 323 in the unchanged DAPT group. The primary endpoint occurred in 43 (13.4%) patients in the switched DAPT group and in 85 (26.3%) patients in the unchanged DAPT (HR 95%CI 0.48 (0.34-0.68), P < 0.01). No significant differences were reported on ischaemic endpoints, while BARC ≥ 2 bleeding occurred in 13 (4.0%) patients in the switched DAPT and in 48 (14.9%) in the unchanged DAPT group (HR 95%CI 0.30 (0.18-0.50), P < 0.01). CONCLUSION: A switched DAPT is superior to an unchanged DAPT strategy to prevent bleeding complications without increase in ischaemic events following ACS. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Newer P2Y12 blockers (prasugrel and ticagrelor) demonstrated significant ischaemic benefit over clopidogrel after acute coronary syndrome (ACS). However, both drugs are associated with an increase in bleeding complications. The objective of the present study was to evaluate the benefit of switching dual antiplatelet therapy (DAPT) from aspirin plus a newer P2Y12 blocker to aspirin plus clopidogrel 1 month after ACS. METHODS AND RESULTS: We performed an open-label, monocentric, and randomized trial. From March 2014 to April 2016, patients admitted with ACS requiring coronary intervention, on aspirin and a newer P2Y12 blocker and without adverse event at 1 month, were assigned to switch to aspirin and clopidogrel (switched DAPT) or continuation of their drug regimen (unchanged DAPT). The primary outcome was a composite of cardiovascular death, urgent revascularization, stroke and bleeding as defined by the Bleeding Academic Research Consortium (BARC) classification ≥2 at 1 year post ACS. Six hundred and forty six patients were randomized and 645 analysed, corresponding to 322 patients in the switched DAPT and 323 in the unchanged DAPT group. The primary endpoint occurred in 43 (13.4%) patients in the switched DAPT group and in 85 (26.3%) patients in the unchanged DAPT (HR 95%CI 0.48 (0.34-0.68), P < 0.01). No significant differences were reported on ischaemic endpoints, while BARC ≥ 2 bleeding occurred in 13 (4.0%) patients in the switched DAPT and in 48 (14.9%) in the unchanged DAPT group (HR 95%CI 0.30 (0.18-0.50), P < 0.01). CONCLUSION: A switched DAPT is superior to an unchanged DAPT strategy to prevent bleeding complications without increase in ischaemic events following ACS. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Jacek Kubica; Piotr Adamski; Piotr Niezgoda; Aldona Kubica; Przemysław Podhajski; Malwina Barańska; Julia M Umińska; Łukasz Pietrzykowski; Małgorzata Ostrowska; Jolanta M Siller-Matula; Jolita Badarienė; Stanisław Bartuś; Andrzej Budaj; Sławomir Dobrzycki; Łukasz Fidor; Mariusz Gąsior; Jacek Gessek; Marek Gierlotka; Robert Gil; Jarosław Gorący; Paweł Grzelakowski; Tomasz Hajdukiewicz; Miłosz Jaguszewski; Marianna Janion; Jarosław Kasprzak; Adam Kern; Artur Klecha; Andrzej Kleinrok; Wacław Kochman; Bartosz Krakowiak; Jacek Legutko; Maciej Lesiak; Marcin Nosal; Grzegorz Piotrowski; Andrzej Przybylski; Tomasz Roleder; Grzegorz Skonieczny; Grzegorz Sobieszek; Agnieszka Tycińska; Dariusz Wojciechowski; Wojciech Wojakowski; Jarosław Wójcik; Marzenna Zielińska; Aleksander Żurakowski; Giuseppe Specchia; Diana A Gorog; Eliano P Navarese Journal: Cardiol J Date: 2021-06-07 Impact factor: 2.737
Authors: Seng Chan You; Yeunsook Rho; Behnood Bikdeli; Jiwoo Kim; Anastasios Siapos; James Weaver; Ajit Londhe; Jaehyeong Cho; Jimyung Park; Martijn Schuemie; Marc A Suchard; David Madigan; George Hripcsak; Aakriti Gupta; Christian G Reich; Patrick B Ryan; Rae Woong Park; Harlan M Krumholz Journal: JAMA Date: 2020-10-27 Impact factor: 56.272